UIC Hospital: Week 1

March 20-24

Hi everyone!

Today ends the first week here, and I think it's great! My biggest complaint is the 1 hr-45 minute commute. Tough business, considering I've had such an easy commute to my other placement, and to WJSHC while I was in Iowa (where I lived across from the dental school).

They are the only two SLPs in the hospital, Kim and Caroline. Kim's supposed to be my official supervisor, but she's out this week. Caroline was out last week, so she has been in charge of me while trying to catch up from being out. Caroline is awesome. She is a fast talker, laid back, and super knowledgable. I assume Kim is too. They insist on the hands-on learning approach, with little observation, where I do a lot of things on my own so I can get my own "groove" before I'm observed later. If that doesn't make sense, keep reading.

I start at 8am, and finish by 3 or 3:30 every day!!! No staying late, No student project, No work at home! I've got my own office, computer, and phone, but I'm not there often because I have to use one of their computers to write SOAP notes - something to do with security. I basically put my stuff in my office, and maybe sort the papers and stuff I'll need for the day. I've got to wear scrubs and a white coat all the time. I also got a radiation badge (what you wear when you do video swallow studies).

The first day, I told Caroline that I observed most of the time at Children's, and insisted that I'll be very independent here ("You'll be in charge of your own day"). She explained a couple orientation things, then sent me to get my radiation badge. When I came back, I hung out in my office and my phone rang! Picked it up, and it was Caroline saying to meet her on the 6th floor in 20 minutes, and in the meantime look over the BDAE because I'll administer it soon!

When I met her upstairs and we stopped outside the patient's room, and she told me her diagnosis and everything. She explained that she had a sub-arachnoid hemorrhage some time ago, but the residual blood left in the area is an irritant on the brain which causes vasospasms. She went into a lot more detailed than that (regarding pressure in the brain and etc.), but that's the gist. I could tell immediately that she's big on knowing and understanding the anatomical basis of behavioral symptoms! She's JUST what I need, because I feel like that information is only floating around in my head (especially after cramming for comps so recently ago) and it all needs to come together. Later my thoughts were confirmed after we looked at her MRI on the computer (she said "only radiologists are supposed to analyze these, but I can't see why we can't look at them too"), and she pointed out parts of the brain down to the globus pallidus of the basal ganglia in an axial view! Oh, further confirmation when she said later that day that the most important things that we want to find out is whether their symptoms make sense with their brain damage. Personally, I thought we were taught to consider the functional impacts of their symptoms. But oh well, to each her own :-) I'm sure she was only referring to these acute patients when we are doing a diagnosis.

We went into the room and she introduced both of us to the patient, explaining that I'll be doing the test. Then she asked me if I'm ready. I said I thought so, then she said "alright, I'll be out there if you need me" (pointing to the nurse's station), or page her if I couldn't find her.

"HOLY COW", I thought to myself -- I'm gonna be all alone! This is within the first couple hours of meeting me and she wasnt' even planning on seeing how I do! I don't think I had ever been completely alone with a patient before like that. At first I was really nervous, but very soon after she left, I realized that this person has neurological damage, and there's no family around so there's no way I can make a fool of myself! I was able to really relax then, and sit on her bed and proceed calmly, taking my time, and feeling free to flip pages around and write what I want. At UIHC, I always felt pressured - to perform, to do everything right in the right order with the right timing... etc. Can't really compare to the VA because we didnt' see acute patients.

Well, to sum up, the rest of the week I've gotten even more independence. In the morning, she gives me a list of patients (and she's got her own, much longer list). These are all language/cognitive rehab or eval patients, so no dysphagia yet, which is fine by me. There's usually 6-7 on the list, and I only end up seeing 3-4 on my own. We go over each of them because she has to tell me the dx of the ones I haven't seen yet (since I'm not allowed access to the system), and asks me if I have any questions or if I want her to join me for any of them. Now, her definition of "join" is different from mine. She'll usually just introduce herself and me, explain what I'll be doing, and then leave. There were a couple which she did the whole thing - one where the wife was present and had a lot of questions (thank goodnes Caroline was there), and the other the guy was too sedated to participate fully in the test I was supposed to give.

So I only see Caroline for part of the day. I write my SOAP notes in Kim's office since she's out, and they are a bit longer than at Children's, but still definately not Dr. Gordon's lengths... hehe. After I finish writing, I save to a disk and bring it to Caroline, who looks it over and copy/pastes to the system. By the way, I can eat lunch whenever I want! She really doesn't care how I spend the day, as long as I see the patients and write up the notes. I think I do have to finish the notes by 2:30 so she can review them and we can leave on time.

Caroline likes to see all the patients in a row in the morning, then write all her notes during lunch and in the afternoon. I like to try that, but first of all I can't remember all the informatino from one patient to the next without writing it down right after, and second of all, not everyone's available when I want.

Anyway, this post is getting long. One more thing to mention that I did yesterday - a pediatric videoflouroscopic swallow study! I haven't seen any VFSS with Caroline yet except for this one. The baby was 14 days old and had a lot of neuro problems. The way they do it here is super duper extremely way opposite of Children's! Caroline put me in charge of THAT session, and THAT was another surprise! She said I should know a lot more htan she does about it, so I am in charge. Turns out I think I do know more! The pediatric radiologist, Dr. Shay, is an old guy who works both here and Childrens, and he says he gets really annoyed with the SLPs there because they are so picky about everything. Good grief, don't get me started about that - I happen to agree with the SLPs at Children's (probably because I just spent 8.5 weeks with them), because there were SO many things that I wanted to change even from that one session! But then again, Dr. Shay has ... let's say... 'been around the block' for a really long time, and he's got to know what he's doing.

Well, this post is long enough. I could've gone for just as long about how the VFSS went, but I'm tired, and I called in sick today :-( But I should be fine - just a cold I think. Till next time, then, girls! Don't forget to comment about what you want me to comment about! :-) Otherwise I'll just ramble on like this post haha. Cheers!